An 8-year-old boy presents with acute encephalopathy (confusion progressing to lethargy), fever, and multifocal neurologic deficits (right hemiparesis, dysarthria, ataxia) beginning 10 days after a febrile upper respiratory illness. MRI brain shows multiple large, ill-defined, asymmetric T2/FLAIR hyperintensities in subcortical white matter bilaterally with involvement of thalami, basal ganglia, and cerebellum. Many lesions show simultaneous gadolinium enhancement. The condition marked **A** in the diagram is suspected. Which of the following is the MOST CHARACTERISTIC distinguishing feature of this condition compared to multiple sclerosis?
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